Robin Williams' death reignites depression and addiction debate

Years of research and mountains of evidence show that addiction and depression are bona fide diseases, and that suicide or the accidental overdose are not choices but biological compulsions beyond the person’s control.

So then why does a bitter debate rage on social media in which posters are clearly divided into two camps: Those who have empathy for people like comedian Robin Williams and actor Philip Seymour Hoffman — and those who do not.

Some experts say that, sadly, they’re not surprised.

“If you announce you have cancer, the whole community rallies around you. But if you say you have depression, you are shunned,” said Dr. Jill Williams, professor of psychiatry at Rutgers Robert Wood Johnson Medical School.

“We have come such a long way in terms of reducing the stigma – and yet we are still 25 years behind, in the field of psychiatry and mental health. And that’s because psychiatry and mental health are always the lowest priorities in the field of medicine,” she added.

In a given year, 18.8 million American adults (9.5 percent of the adult population) will suffer from a depressive illness, according to the latest data from the Centers for Disease Control and Prevention, and an estimated 20 percent of people aged 55 years or older experience some type of mental health issue.

Depression is the most prevalent mental health problem among older adults. Approximately 80 percent of persons with depression reported some level of functional impairment because of their depression, and 27 percent reported serious difficulties in work and home life.

“So it’s not uncommon,” Will­iams said. “And yet, there are still people who tend to say it’s the person’s fault. We blame them. And there is stigma, and shame. I wish society would change, and value behavioral health. I do. But I think we have a long way to go. There’s still so much about the brain we don’t understand.”

There’s one thing that science does understand: “People don’t choose these things.”

Drug addiction and depression are two distinct illnesses that sometimes become intertwined by the depressive’s need to self-medicate with alcohol or drugs. According to the CDC’s most recent findings, drug overdoses were responsible for 38,329 deaths in 2010, 30,006 of which were unintentional. That’s a rate of 105 every day, and that number doesn’t take into account the 6,748 people treated every day for the misuse or abuse of drugs.

In comparison, traffic accidents were responsible for 33,687 deaths in 2010. Firearms killed 31,672 people, and 26,852 died as a result of falling. The CDC reports that drug overdose death rates have risen steadily since 1992, seeing a 102 percent increase from 1999 to 2010. In 60 percent of all overdose deaths, prescription pharmaceuticals were to blame.

And yet, despite all that, the health insurance establishment is generally unsupportive of drug addiction treatment, said Dr. Diego Coira, chairman of the Department of Psychiatric and Behavioral Medicine at Hackensack University Medical Center.

“It’s starting to get better. But overall, it’s very hard to get insurance companies to pay. Treatment for addictions usually requires long hospitalizations – sometimes two or three months of in-patient rehab,” he said. “We, as a society, the insurance companies, don’t want to pay for it. Some people think the person can just snap out of it.”

People who believe that those afflicted with depression or addiction can “just snap out of it” have a platform on social media that can perpetuate bad information and heighten the stigma, according to Duy Linh Tu, assistant professor of professional practice and director of the digital media program at Columbia Journalism School.

“It’s the amplification of information – both good and bad. The problem with the bad commentary is when it gets repeated over and over again, it has a danger of becoming ‘fact.’ That’s fine, if you’re talking about ‘Game of Thrones.’ But when you get into something medical, it becomes dangerous.”

Dangerous not only in terms of perpetuating myths – but in worsening the pain of those already suffering. “I do think there’s a danger in having the trolls of the world going online and saying, ‘He is a coward.’ Because there are people who can take that as a reflection of themselves and think, ‘Hey, maybe I AM a coward.’ It’s easy to say, ‘Well, it’s just some idiot talking.’ But how do you tune out that much noise?” Tu said.

As powerful and even harmful as words on social media can be, experts say it’s still better to have the discussion on such a world stage – viciousness, ignorance and all – than to not have it at all.

“There is a long, vitriolic invective going on,” said Aram Sinn­reich, assistant professor of media at Rutgers University. “I think this debate about whether people with mental illness are victims or perpetrators of their own fates has been going on a long, long time and predates social media. But now there is a much more nuanced conversation that happens. You have people who are dealing with these issues in their daily lives, sharing their feelings intimately on the subject, which was not the case before.

“The flip side is you have every Tom, Dick and Mary chiming in, and they are falsely coddled by the illusion that their participation is anonymous, sharing the worst they could possibly say about people’s suffering,” he added. “In the old days, if someone had something nasty to say, it would be easy to avoid it. It used to be around the office water cooler. Now, it can be seen by millions of people.”

As for depression and public perception, Dr. Sharad Wagle, chief of psychiatry at Holy Name Medical Center in Teaneck, said: “People don’t recognize how much pain someone is in unless they go through it themselves. Some people are just insensitive that way. The more severe the mental illness, the more unbearable the pain. So instead of saying, ‘He’s so weak he committed suicide,’ think of it as, ‘He is in love with his children but he decided to commit suicide anyway. That’s how much pain he was in.’Ÿ”

Add celebrity to the mix, and the public has an even harder time sympathizing with how someone with so much fame and fortune could throw it all away.

“As with the premature death of any celebrity, there are also people who are taking a hard line that the only person to blame for Robin Williams’ death is Robin Williams,” wrote Alexis Rhiannon, an editor at crushable.com, a national entertainment and lifestyle web site. “That he should have tried harder. That he should have thought of his kids. … Robin chose to hang himself, just like Phillip Seymour Hoffman chose to inject his veins with heroin. There’s no denying that it was their hands responsible for that final act.”

However, the post adds, “These are people who stood up and admitted that they needed help, asked for it, sought it out over the years, and there’s honestly nothing braver than that. … Even if you’re one of those people who deny that addiction is a disease (please don’t get me started), the evidence is overwhelming that people like Robin, Philip Seymour Hoffman, and other celebrities in recovery don’t want to do drugs or struggle with depression.”

Also shared among 249,000 Facebook fans and 1,500 Twitter account holders is a piece by blogger Matt Walsh of themattwalshblog.com, who wrote last week: “Your suicide doesn’t happen to you; it doesn’t attack you like cancer or descend upon you like a tornado. It is a decision made by an individual. A bad decision. … We tend to look for the easiest answers. It makes us feel better to say that depression is only a disease and that there is no will and choice in suicide, as if a person who kills themselves is as much a victim as someone who succumbs to leukemia.”

Within seconds, he was inundated by angry responses. One such response, from a person who said he has struggled with depression his whole life. “If I commit suicide, perhaps, as you claim, it will be ‘my’ choice. But I doubt it. I have spent more than half my life listening to my own body betray me, my own mind telling me that it would be better to die. And while my external life circumstances have varied how tempting those whispers are, nothing has ever gone so well that they have stopped. No saving relationship with my Lord Jesus Christ. No compassionate bride holding my hands at the altar. No giggling twins in my arms. Nothing has made depression go away.”

It’s a difficult exchange. But in the end, a valuable one, said Tu.

“Discussion is important. Sometimes it’s ugly. Sometimes it’s profane,” he said. “But I’ll take a world that has more discussion over one with silence.”